Scotland Graham, Bryan Stirling
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK (GS, SB).
Health Services Research Unit, University of Aberdeen, Aberdeen, UK (GS).
Med Decis Making. 2017 Feb;37(2):139-147. doi: 10.1177/0272989X16653397. Epub 2016 Jul 10.
At a time of intense pressure on health care budgets, the technology management challenge is for disinvestment in low-value technologies and reinvestment in higher value alternatives. The aim of this article is to explore ways in which health economists might begin to redress the observed imbalance between the evaluation of new and existing in-use technologies. The argument is not against evaluating new technologies but in favor of the "search for efficiency," where the ultimate objective is to identify reallocations that improve population health in the face of resource scarcity. We explore why in-use technologies may be of low value and consider how economic evaluation analysts might embrace a broader efficiency lens, first through "technology management" (a process of analysis and evidence-informed decision making throughout a technology's life cycle) and progressing through "pathway management" (the search for efficiency gains across entire clinical care pathways). A number of model-based examples are used to illustrate the approaches.
在医疗保健预算面临巨大压力之际，技术管理面临的挑战是减少对低价值技术的投资，并将资金重新投入到更高价值的替代技术中。本文旨在探讨卫生经济学家如何开始纠正新的和现有在用技术评估之间存在的明显失衡。本文的观点并非反对评估新技术，而是支持“追求效率”，其最终目标是在资源稀缺的情况下确定能够改善人群健康状况的资源重新分配方式。我们探讨了在用技术可能价值较低的原因，并思考经济评估分析师如何通过更广阔的效率视角，首先是通过“技术管理”（在技术的整个生命周期内进行分析和基于证据的决策过程），进而发展到“路径管理”（在整个临床护理路径中寻求效率提升）。文中使用了一些基于模型的示例来说明这些方法。
